Abstract

Qualitative Research is enjoying a new found respectability in medical
sociology, derived in part from an increasing willingness to submit to
positivist criteria of reliability and validity. Whilst such claims to
'scientific' credibility have raised the status of the approach, this has
only been achieved by driving a wedge between ethnographic methods of
data-collection and their origins in the phenomenological strands of
sociological thought. One consequence of this schism has been to rob
qualitative research of its critical potential, transforming it from a
means of challenging discursive formations into a mechanism of
surveillance.

This paper defines the broad contours of a qualitative methodology
synthesised with the perspective of social critique. Positivist arguments
are rebutted and validity is re-conceptualised as reflexive management of
the relationship between the testimony of informants and a broader process
of historical and structural analysis. The process of managing validity is
illustrated for each stage of the research cycle.

Introduction

Qualitative methods of inquiry have often been viewed with ambivalence
and a degree of trepidation by researchers concerned with the sociology of
health. On one hand such methods offer an important link to some of the
main concerns of sociological thought, addressing questions of power,
ideology and subjective meaning. Whilst on the other hand, they may be
viewed as suspect in terms of their validity and reliability, particularly
when compared with the more 'scientific' methods available to the
quantitative researcher. Traditionally, scepticism about the value of
qualitative methods has been strongest in the sub-discipline of medical
sociology where, until quite recently, the dominance of a positivist model
of bio-medical research has tended to exclude phenomenological
approaches.

Over the last ten years the situation has begun to change, and
qualitative research has gradually acquired a new respectability, with
even the British Medical Journal, prepared to recognise its worth
(Mays & Pope, 1995). But this new found
acceptance has been achieved at a cost; most notably it has entailed, if
not a complete capitulation to quantitative criteria of validity and
reliability, at least a tendency to meet them half-way. Whilst this
compromise has undoubtedly raised the status and acceptability of
qualitative research it has also weakened the link between the technical
process of ethnographic data collection and its basis in sociological
theory. One consequence of this schism has been to rob the methodology of
its critical content - the assumption appears to be that qualitative
research can be valid, or it can be critical, but not both at the same
time. The purpose of this paper is to refute that pessimistic conclusion
by sketching out the broad contours of a qualitative research model that
is not only critical, but also valid and reliable on its own terms, rather
than in accordance with the narrow constraints of positivism.

What is qualitative research?

Generally, qualitative research can be characterised as the attempt to
obtain an in-depth understanding of the meanings and 'definitions of the
situation' presented by informants, rather than the production of a
quantitative 'measurement' of their characteristics or behaviour. This
concern to reveal the subjective beliefs of those being studied is common
to ethnography, participant observation, and the various other strands of
qualitative research. For many qualitative researchers the subjective
beliefs of the people being studied have explanatory primacy over the
theoretical knowledge of the researcher, thus Jorgensen suggests:

While the researcher may have a theoretical interest in being
there, exactly what concepts are important, how they are or are not
related, and what, therefore, is problematic should remain open and
subject to refinement and definition based on what the researcher is able
to uncover and observe. (Jorgensen,
1989, p. 18)

The ethnographer's concern to avoid imposing a theoretical framework of
meanings and definitions perhaps originates from the anthropological study
of low technology tribal cultures in the third world, where the intention
was mainly to describe cross-cultural variations in social behaviour and
beliefs before they disappeared. Methodologically this entailed detailed
observation and interaction by the researcher, in order to see the world
'through the eyes' of the people being studied. The same approach has
been adapted to the study of sub-cultures within western society, most
notably in the classic studies conducted by the Chicago School and
succeeding generations of neo-Chicagoans. As Downes and Rock have noted,
the primary imperative for such research is to catalogue and describe a
particular worldview without imposing external theoretical schema:

The interactionist takes his job to be the documentation of
the social worlds that constitute a society. He methodically plots the
connections between communication, meaning, symbolism, and action. He
would claim that there is little profit in imposing alien interpretative
schemes on a world: people do not build their lives on the logic of
sociology or the sensibilities of foreign groups. They have their own
methods of doing things together. (Downes &
Rock, 1986, p. 143)

Whilst this approach has yielded a diverse and colourful variety of
descriptions of everyday life, it poses a number of problems or
limitations when viewed from the perspective of critical social research.
First, no attempt is made to place the beliefs and behaviour of the people
being studied into an historical or structural context; it is considered
sufficient to simply describe different forms of consciousness without
trying to explain how and why they developed. This leads to a second
problem - the tendency to adopt an uncritical attitude to the beliefs and
consciousness of informants, without considering their epistemological
adequacy or their emancipatory potential. The result is a form of
voyeuristic relativism where everyone's testimony is accorded equal
status, and no attempt is made either to explain or inform the development
of consciousness.

Superficially, such an approach appears to be the epitome of a
value-free sociology; rather than passing judgement on the lives of others
the researcher becomes an impartial reporter enabling informants to
express their own definition of the situation. However, the reluctance to
address the processes by which different forms of consciousness are
socially and historically constructed, coupled with the absence of any
evaluation of the epistemological status and emancipatory potential of a
set of beliefs, amounts to little more than a passive legitimation of
dominant ideology. Moreover, it is based on an assumed antagonism between
social theory and the immediate experience of everyday life. Rather than
the means of obtaining a critical consciousness of ideological oppression,
social theory is conceptualised as an inevitable part of the dominant
ideology - something to be resisted and struggled against, rather than a
basis for emancipatory activity. In short, it is assumed that the
sociologist has everything to learn from the people she or he studies, but
that critical social theory can have no reciprocal role in their
emancipation.

In the light of such criticisms a new generation of 'critical'
ethnographers (see Hammersley, 1992)
have attempted to synthesise the traditional focus on the meanings and
definitions of those involved in a social phenomenon with the insights
gained from social critique. The objective is still to access the
subjective beliefs of the people being studied, but rather than accepting
such beliefs at face value they are examined critically in the context of
a broader historical and structural analysis. Whilst Hammersley is keen to
distance himself from critical ethnography, he recognises the value of
this shift in emphasis:

...we have no grounds for dismissing the validity of
participant understandings outright: indeed they are a crucial source of
knowledge, deriving as they do from experience of the social world.
However, they are certainly not immune to assessment, nor to explanation.
They must be treated in exactly the same manner as social scientific
accounts. (Hammersley & Atkinson, 1983, p.
234)

Crucially, appraisal of the testimony of respondents amounts to much
more than simply checking that they are telling the truth, it entails
looking at the processes that shaped their views and assessing the extent
to which they may be distorted by ideology. The intention is not primarily
to 'weed-out' unreliable testimony, but to use historical analysis and
sociological theory to get beneath the surface of everyday 'common-sense'
assumptions in order to arrive at a deeper level of understanding that
will not only be of academic interest to the researcher, but will also
contribute to the development of critical consciousness amongst oppressed
groups. However, the synthesis of ethnography and critical social research
is an uneasy one, not least because it necessitates a re-conceptualisation
of validity, in a form quite different to that adopted by traditional
ethnography or positivist empiricism. The purpose here is to commence this
reconceptualisation, and in so doing reclaim qualitative methods for a
critical sociology.

What is critical social research?

Critical inquiry is diverse and flexible and only takes on a specific
form when applied to the study of a particular phenomenon. Even so, the
approach has several essential elements, and the intention is to summarise
them in order to arrive at a deeper understanding of the perspective, and
its consequences for ethnographic validity.

At the core of a genuinely critical methodology lies the application of
dialectical logic. Dialectical reasoning is complex, and only a brief
account can be given here. Essentially, the approach addresses the
relationship between objects and events in the material world and their
subjective representation in human consciousness. The dialectical
character of this relationship was addressed by G. W. F. Hegel, but he
took as his point of departure the realm of ideas, or human spirit, and
was concerned with the way in which human thought became materialised
through practical activity. From this perspective the individual's
knowledge of the world was essentially knowledge of materialised, and
therefore alienated, human thought. Through practical activity the
individual could overcome his/her alienation and re-appropriate the human
spirit as it had been externalised by previous generations. Ilyenkov gives
an eloquent account of Hegel's approach:

This world was the materialised thought of humanity, realised
in the product, was alienated thought in general; and the individual had
to de-objectify, and arrogate to himself, the modes of activity that were
realised in it, and it was in that the process of his education properly
consisted. In the trained mind categories actually functioned as active
forms of thought activity, forms of processing the material of sense
impressions into the form of a concept. When the individual had them in
his experience, and made them forms of his own activity, he also possessed
them, and knew and realised them, as thought-forms. Otherwise they
remained only general forms of the things given in contemplation
and representation, and counterposed to thought as a reality existing
outside it and independently of it. (Ilyenkov, 1977, p. 208)

Thus Hegel shifted the focus of logic towards consideration of sensuous
human activity, and indicated the extent to which the products of human
thought and intervention in nature take on a naturalised and ahistorical
appearance. Much of Hegel's logic is retained in modern dialectical
thought, but for one fundamental difference. By starting in the realm of
ideas and examining their impact on the material world, Hegel was unable
to account for the origins of those thoughts, and was obliged to rely on
an essentialist and metaphysical account of the 'human spirit'. Vulgar
materialists, like Ludwig Feuerbach, noted that this amounted to little
more than religious belief, and sought to ground human consciousness in
experience of the material world. Thus for Feuerbach it was the real world
that became imprinted on the physical human brain, rather than the
unfolding of the human spirit that gave rise to the world.

Although Feuerbach's account of human consciousness dispenses with the
idealism of Hegel's approach, it only does so at the cost of perceiving
humanity as the passive recipient of data from the material world. It took
Marx to combine the materialist basis of consciousness identified by
Feuerbach, with the dialectical insights of Hegel. For Marx, consciousness
came from the individual's experience of the real world, but this
experience was one of practical activity, of conscious intervention to
adapt nature to meet human needs. From this perspective phenomena could
still be identified as socially constructed, that is, as the product of
human will, without resorting to a metaphysical account of 'human spirit'.
Ilyenkov has noted the advance that this represents over vulgar
materialism:

Materialism in this case does not consist at all in
identifying the ideal with the material processes taking place in the
head. Materialism is expressed here in understanding that the ideal, as a
socially determined form of the activity of man creating an object in one
form or another, is engendered and exists not in the head but with the
help of the head in the real objective activity (activity on things) of
man as the active agent of social production. (Ilyenkov, 1977, p. 261)

Importantly, the human head is not seen as a purely physical entity,
but as a social head, full of socially constructed information on how to
understand and act in the world, for example, language, concepts and
categories. The focus on conscious human activity (production in its
broadest sense), essential to the materialist conception of dialectics,
re-introduces Hegel's problematic, but sets it on a materialist footing -
effectively turning Hegel on his head, as Marx put it. The problem resides
in the gap between socially constructed phenomena as they exist in the
real world, and the equally socially constructed representations of those
phenomena in the consciousness of the individual. The key to this problem
is the continuing process of change over time. First, the world in which
we find ourselves is in a constant state of flux, requiring us to
constantly act upon it, and constantly represent that process in
consciousness. Unfortunately, as we know from Hegel, the phenomenal forms
through which we grasp reality are constructed over generations, and may
therefore present themselves to the individual as static and immutable.
The application of dialectical logic enables us to recognise the
historical specificity and social construction of prevailing phenomenal
forms, in order that we can act to consciously transform them, and better
satisfy our needs and wants.

The dialectical logic revealed by Marx reflected the largely
unconscious technique used by other scientists, for example, Darwin had
been able to reveal an organic world in a constant state of flux, where
minute quantitative changes over time led to the qualitative
transformation from one species to another. That we bother to assign fixed
labels to things which are constantly changing is a matter of practicality
rather than precision - we name things in order to understand them, so
that we might use them to meet our needs. However, the fixity of meaning
implied in the act of naming cannot keep up with a world that is
constantly changing, leading us to continually revise our knowledge of
the world. In this sense a body of knowledge is always historically
specific. This does not imply the adoption of a relativist epistemology,
because at any given moment some truth claims will grasp reality more
adequately than others. The importance of dialectical logic is that it
enables us to choose between alternative truth claims without losing sight
of their historical specificity and transitoriness.

The adoption of dialectical logic has a series of methodological
consequences for critical social research. First, it is essential to study
the historical development of a phenomenon to reveal changes in the way it
has been conceptualised over time. The purpose of studying a phenomenon
over time is not simply to record changes in its appearance or phenomenal
form, but to reveal the nature of the relationship between the
phenomenon's appearance and its underlying essence. We noted above that
the production of knowledge involves abstraction from the material world
to the theoretical world, in order to better inform our practical
activity. The dialectical approach problematises this relationship between
objective reality and our attempts to represent it in knowledge. Part of
the problem is that objective reality is in a constant state of flux and
our attempts to grasp it through categorisation and definition must
inevitably become out-dated or inadequate over time. The purpose of
studying a phenomenon over time is, therefore, to reveal the historical
specificity of phenomenal forms and the extent to which they are socially
constructed.

The relationship between essence and appearance is not only problematic
because phenomenal forms become outdated in the face of constant changes
in the material world, but also because the historically specific
categories through which we grasp the material world also have a political
dimension in that they enable powerful groups to exercise domination over
less powerful groups. Thus, the second element of social critique is the
deconstruction of categories or phenomenal forms. This does not simply
entail the production of a detailed description of the material contents
of a given category, but an attempt to reveal the extent to which the
existence of a category depends upon a series of relationships with other
phenomena in the social and economic totality. For example, an uncritical
definition of the category 'working class' might produce a list of
occupations, or an income band, or cultural characteristics such as
educational attainment or 'lifestyle choices'. A critical account, by
contrast, would attempt to locate the category in a series of social and
economic relations.

Viewing a phenomenon as the product of a whole network of social and
economic relations, does not mean that all of those social relations
carry equal explanatory potential. It may be possible to find a key
relationship or 'overriding moment'; for example, with the category
'working class' the key relationship might be that workers are obliged to
sell their labour power to the private owners of capital, thereby
forfeiting their right to exercise conscious control over the production
and distribution of goods and services. This process of deconstructing a
phenomenal form or explanatory category is fundamentally empirical; it is
grounded in observation of phenomena in the real world at a specific
location in time and space, and cannot be dogmatically generalised to a
different context.

Critique of categories has a series of effects. First, it shifts
explanatory emphasis from the categories themselves to the social
relations that underpin them. This makes the categories derived from such
analysis more enduring over time. For example, if the working class is
defined in terms of particular occupations or cultural attributes, then
the term must inevitably become redundant as the labour market changes and
different cultural patterns emerge. For instance, it is often remarked
that the working class has declined as a result of the re-structuring of
manufacturing industry (Gorz, 1982), however,
if the category is defined in terms of the relationship between labour and
capital, then the category continues to be of value while ever that
relationship endures, even though its demographic content may change over
time.

A second effect of deconstruction is that in laying bare the essence of
a phenomenon by locating its conditions of existence in a specific network
of social and economic relations it also reveals political factors that
cannot be grasped from its surface appearance. The classic example is
Marx's critique of the phenomenal forms of bourgeois political economy (Marx, 1887/1983), which revealed the essentially
exploitative and coercive relations that lie behind the apparent freedom
and equity of commodity production. The hidden political nature of
phenomenal forms is not only to be found in class relations, but anywhere
that knowledge is implicated in the domination of one group by another,
for example, around gender and race. The objective of critical social
research is to make such oppressive structures overt in order that they
might be challenged.

This relationship between critical social research and political
activity is two-fold. First, for the critical social researcher the
distinction between the material world and its abstract representation in
knowledge is not absolute. As well as having an existence as text or as
ideas, knowledge is also externalised through our conscious manipulation
of material objects, for example, even a very basic manufactured object
like a spoon has more than a purely physical existence; as well as being a
piece of metal it is also a consciously designed instrument that can be
used in a specific way to solve a specific problem. This process of
externalising conscious knowledge to give it a material existence extends
beyond the production of basic tools to include the built environment,
social and economic institutions, et cetera. Thus, the production of an
alternative body of knowledge entails much more than abstract
re-conceptualisation of the material world, or the production of a text,
it entails the transformation of the phenomenal forms of knowledge, that
is the material objects, institutions and processes in which previous
knowledge is embedded. As Lee Harvey has noted:

Knowledge changes not simply as a result of reflection but as
a result of activity too. Knowledge changes as a result of praxis.
Similarly what we know informs praxis. Knowledge is dynamic, not because
we uncover more grains of sand for the bucket but because of a process of
fundamental reconceptualisation which is only possible as a result of
direct engagement with the processes and structures which generate
knowledge. (Harvey, 1990, p.
23)

This unity between the subjective and objective world underlines the
political basis of critical social research. The point is not simply to
reveal the oppressive aspects of existing phenomenal forms as an end in
itself, but to embed this knowledge in the consciousness of the oppressed
in order that they might engage in practical activity to emancipate
themselves. Füredi suggests that:

The power of Marxist theory is derived, not from the elegance
of its arguments, but from its capacity to make conscious the unconscious
forces driving towards social change. (Füredi, 1990, p. xxiii)

We noted above that the relationship between theory and practice is not
uni-linear. Whilst the objective of critical social research is to inform
conscious activity, it also derives its validity from active involvement
in political struggle. From this perspective the production of knowledge
is deeply embedded in the process of social transformation; both
informing, and derived from, the struggle to consciously change the
material world.

To summarise, although critical social research is diverse and
constantly developing the following characteristics are essential to the
approach: the application of dialectical logic which views the material
and social world as in a constant state of flux; the study of phenomena
over time to reveal their historical specificity; the critique or
deconstruction of existing phenomenal forms and analytical categories that
delves beneath the superficial appearances available to unaided common
sense to reveal the network of social and economic relations that are the
essential conditions of existence for a phenomenon; the exposure of
previously hidden oppressive structures; and a praxiological orientation
in which knowledge is considered to be inseparable from conscious
practical activity. But the question still remains as to whether this
approach can be synthesised with ethnography and still constitute a valid
methodology.

Can qualitative research be critical and
valid?

Not all critical ethnographers would agree with the above definition of
social critique, although, most would presumably agree that critical
ethnography entails synthesising the subjective testimony of informants
with a broader historical and structural analysis. But this synthesis of
the insights that traditional ethnography provides into the subjective
experience of everyday life, with the historical and structural insights
offered by social critique, is by no means easy to maintain. Not least
because it entails combining two quite separate and possibly incompatible
formulations of validity. The possibility always remains that the analysis
will slide into either a top-down deductive approach in which a
pre-existing theory is simply legitimated by the selective and biased use
of ethnographic data, or else into a superficial and particularistic
account of the views of respondents. Giving explanatory primacy to the
testimony of informants would appear to undermine the validity of social
critique by contravening the injunction to always look beneath the surface
of everyday appearances; whilst a broader historical and structural
analysis might contradict the traditional ethnographer's claim that valid
research does not impose a priori theoretical constructs.

The solution to this dilemma lies in ensuring that the analysis is
informed by both strands of inquiry, for example, that issues emerging
from participant observation or ethnographic data can be placed in an
historical and structural context, and that problems identified in the
academic literature can influence the direction of the ethnographic study.
As such, critical ethnography entails a constant inter-weaving of
inductive and deductive logic. The researcher does not set out to test a
pre-conceived hypothesis, nor is an entirely open-ended approach adopted,
instead the researcher begins by observing the field of study, both as a
participant observer and as a reviewer of academic literature. From the
synthesis of these sources a research agenda emerges that can be pursued,
again, by a mixture of observation and theoretical work.

The key to managing this unstable dialectical relationship between
ethnographic observation and social critique is to re-conceptualise
validity in terms of reflexive practice. Reflexivity refers to the
researcher's conscious self-understanding of the research process (Hammersley & Atkinson, 1983), or more
specifically, to a sceptical approach to the testimony of respondents
(i.e., Are they telling me what I want to hear?), and to the development
of theoretical schema (i.e., Am I seeing what I want to see?). The purpose
of reflexivity is not to produce an objective or value-free account of the
phenomenon, because qualitative research of this kind does not yield
standardised results, as Janet Ward-Schofield has suggested:

...at the heart of the qualitative approach is the assumption
that a piece of qualitative research is very much influenced by the
researcher's individual attributes and perspectives. The goal is not to
produce a standardised set of results that any other careful researcher in
the same situation or studying the same issues would have produced. Rather
it is to produce a coherent and illuminating description of and
perspective on a situation that is based on and consistent with detailed
study of the situation. (Ward-Schofield,
1993, p. 202)

Thus, reflexivity is not primarily a means of demonstrating the
validity of research to an audience, but rather a personal strategy by
which the researcher can manage the analytical oscillation between
observation and theory in a way which is valid to him or herself. Of
course, this will be anathema to the positivist. But is it really so
different to the process of establishing validity in quantitative
research? Random sampling and statistical testing may appear to make the
assessment of validity transparent to a third party, but such techniques
are not immune to manipulation by an unscrupulous researcher. In fact, the
validity of particular research findings, be they qualitative or
quantitative, ultimately depends upon trust in the researchers integrity,
at least until the research is replicated. Validity therefore refers to
the techniques employed by the researcher to indulge a Socratic distaste
for self-deception, and in critical ethnography this is achieved by
reflexivity.

This reflexive management of the research process in the pursuit of
validity applies to each stage of the research process, from establishing
relations in the field to writing up the conclusions. Rather than
presenting a taxonomy of qualitative techniques, participant observation
and in-depth interviewing are presented as the main exemplars of the
ethnographic approach.

Selecting and gaining access to a site

Choosing an appropriate site to study, and forging a relationship with
its participant members, is a key issue for all ethnographic studies. Ward-Schofield (1993) has explored the
consequences of site selection for validity and generalisability, and
suggests that both can be maximised either by selecting a 'typical' site
or else conducting a multi-site study. However, there are problems with
either option; first, how can one identify what constitutes a typical site
without conducting at least a basic reconnaissance of all potential sites?
Secondly, given that most qualitative studies are conducted by single
researchers or small teams, is it viable to study multiple sites to the
depth required by qualitative analysis?

Other commentators set less rigorous standards for site selection, for
example, Jorgensen (1989) refers to a
number of qualitative studies derived from everyday life experiences,
where the researcher literally found him or herself in a fortuitous
location to study a phenomenon. There is more to recommend Jorgensen's
argument than the dictates of pragmatism; rather it constitutes a refusal
to be bound by quantitative criteria of reliability, particularly the
claim that the informants in a qualitative study should be representative
of a broader population. Clearly, if the need to identify a representative
site is accepted, then qualitative research must always appear to be the
poor relation of quantitative methods where random sampling can be
applied. By contrast the ethnographer is more concerned with the validity
of the data she or he collects, that is, with whether or not the data
express the considered and authentic views of the informant, with minimal
interference or distortion by the research process. It is this criteria of
validity (i.e., the potential to access the authentic views of the
informants) that guides the ethnographer's selection of a site, rather
than the largely unattainable goal of representativeness. Again this
process needs to be reflexively managed according to the specific context,
potential considerations include: ease of access to the informants,
whether data can be adequately recorded (either by field notes or
tape-recorder), and crucially, whether there are any characteristics of
the site that might adversely influence an informant's testimony, for
example, the close proximity of his/her employer or spouse. As the context
for qualitative research is infinitely variable the characteristics of an
ideal site cannot be prescribed in advance; hence the need for reflexive
management by the researcher.

Front-end management

Having chosen a site, the researcher must establish contact with the
informants. Again the character of this relationship varies, for example,
from the relatively brief contact of a single in-depth interview, to
participant observation which might entail a close relationship between
researcher and informants lasting several weeks or months. Again,
quantitative criteria of validity cannot be imposed on this aspect of
qualitative research. Although the ethnographer must take care not to
influence the informants in ways which might distort their behaviour or
testimony, the necessity of establishing a rapport in order to gain access
to what might be sensitive or closely guarded information means that the
degree of detachment associated with quantitative research may not be
viable or desirable. Instead, close proximity to the phenomenon being
studied can be viewed as an advantage, for example, some feminist writers
(Stanley, 1990) have gone so far as
suggesting that personal experience can be a vital source of inside
information to be tapped as part of the research process. Nigel Fielding
has also suggested that there may be advantages as well as
disadvantages:

One is participating in order to get detailed data, not to
provide the group with a new member. One must maintain a certain
detachment in order to take that data and interpret it [sic]). But
it is also important to note that another problem is much less remarked in
the literature, though it may be more common. This is the problem of 'not
getting close enough', of adopting an approach which is too superficial
and which merely provides a veneer of plausibility for an analysis to
which the researcher is obviously committed. (Fielding, 1993, p. 158)

Managing the relationship with informants, or 'front end management',
is an important aspect of the validity of any qualitative study, but again
it cannot be prescribed as a specific procedure, and its adequacy or
effectiveness is unlikely to be immediately transparent to a third party.
Whilst a conscious and reflexive attempt to establish valid relations in
the field can be reported by the researcher, and may go some way to
reassuring reviewers and readers, any post-festum assessment of the
validity of this process is ultimately dependent upon trust.

Data collection

Qualitative researchers have a number of techniques at their disposal
for data collection, including non-participant and participant
observation, focus groups, and in-depth interviewing. Each of these
techniques raises particular concerns about validity, for example,
participant observers may have difficulty in taking adequate field notes.
However, there are techniques for overcoming such difficulties, and as
with site selection and front-end management the greater problem resides
in demonstrating validity rather than achieving it.

As noted above, a more fundamental difficulty arises in reconciling the
'bottom-up' approach of qualitative research with the structural and
historical perspective adopted in critical social inquiry. For example,
for many ethnographers the in-depth interview should be entirely open
ended, with at most a series of topics to be discussed, but certainly no
pre-conceived questions, as this would entail the researcher imposing
his/her own definition of the situation rather than enabling the
respondents to structure the research. Thus, Sue Jones suggests that
pre-conceived interview schedules are unacceptable because:

...the interviewers have already predicted, in detail, what is
relevant and meaningful to their respondents about the research topic; and
in doing this they have significantly prestructured the direction of
enquiry within their own frame of reference in ways that give little time
and space for their respondents to elaborate their own. (Jones, 1985, p. 46)

Whilst this may be a valid approach for traditional ethnography, or
where the interview is the researcher's first contact with the respondent,
critical ethnography may entail a much more focused approach to
interviewing, in which questions are asked about specific issues derived
from the broader social critique. This is particularly the case where
extensive participant observation has already revealed issues to be
examined in greater depth in the interviews. Whilst critical ethnographers
are keen not to ask leading questions and to enable informants to express
their views fully, the research agenda and scope of the study are not
primarily determined by the informants. Rather, a dialectical approach is
adopted, allowing the researcher to oscillate between the world view of
the informant, (e.g., by departing from the interview schedule to pursue
an interesting line of inquiry), and the insights offered by the
historical and structural analysis, which may enable the constructs and
categories employed by the informant to be actively deconstructed during
the course of the interview.

The validity of this tendency to structure the research agenda
according to themes raised by social critique is more likely to be
questioned by traditional ethnographers than by quantitative researchers
who are more or less obliged to commence data collection with a
pre-conceived agenda. For the critical ethnographer validity depends upon
getting beneath the surface appearances of everyday life to reveal the
extent to which they are constituted by ideology or discourse. Thus,
rather than commencing the process of data collection with an 'empty head'
the critical ethnographer is pre-armed with insights gleaned from social
critique.

Data analysis

Nigel Fielding (1993, p. 163) has
summarised a common approach to ethnographic data analysis in the
following model:

Fieldnotes
Transcripts

Search for
categories and
patterns (themes)

Mark up
or cut up
the data

Construct
outline
(re-sequence)

Harvey (1990) refers to the same process
as 'pile-building', in which the ethnographic data are first read
'vertically', usually in chronological order, to identify common themes
and relations which are then coded. The data are then literally cut up and
re-ordered into 'piles' that reflect the key themes. Specialist software
is available to facilitate this process, but the 'cut and paste' utility
of a word-processor is likely to be adequate. The re-ordered data are then
re-read, enabling a sequential argument to be constructed, and
illustrative quotations from the transcripts to be selected.

Harvey also suggests that critical ethnography differs from traditional
forms of qualitative data analysis, by bringing the broader critique of
social relations to bear on the structuring of analytical themes. Hence
the final analysis is not derived exclusively from the ethnographic data
but from an oscillation between that and the social critique. As Sue Jones
has noted, this inevitably entails going beyond the concepts and
understandings of the respondents:

I know I cannot empathise with the research participants
completely. I also know that I am likely at some points to set my
understanding of their 'concrete' concepts - those which they use to
organise, interpret, and construct their own world - within my own and/or
an audience's concepts and frameworks that are different from theirs. When
I do this, however, I try to be clear that I am doing this and why, and to
ensure that this 'second level' of meaning retains some link with the
constructions of the research participants. (Jones, 1985, pp. 56-57)

The identification of themes and the selection of quotations to
illustrate them also raises a fundamental issue about the validity of
qualitative research; as David Silverman has noted:

The various forms of ethnography, through which attempts are
made to describe social processes, share a single defect. The critical
reader is forced to ponder whether the researcher has selected only those
fragments of data which support his argument. (Silverman, 1985, p. 140)

Silverman's preferred solution to this dilemma is to introduce simple
counting procedures into the analysis, for example to identify how many
people referred to a specific theme. But this begs the question of how
many people must refer to a theme before it is deemed significant;
moreover with a small quantitative study it is unlikely that a view shared
by a majority of respondents could be claimed as representative of the
views of a broader population. In fact, the application of quantitative
criteria of validity to qualitative data is inappropriate. The rationale
for conducting in-depth interviews is that people involved in a phenomenon
may have insights that would not otherwise be available to the researcher,
and it is the quality of the insight that is important, rather than the
number of respondents that share it. This is what Hammersley meant (in the
above quotation) when he suggested that ethnographic data should be
treated in the same manner as social scientific accounts - when we quote
the work of a particular social scientist we do so because of its
explanatory power, not because it represents a commonly held view, and the
same logic applies to qualitative data.

Mays and Pope (1995) have addressed the
validity issue by recommending that qualitative researchers pass their
ethnographic data to independent researchers to see if they arrive at the
same analysis. But again this is unsatisfactory. How are we to select an
alternative researcher, and how many should we consult before we can
conclude that the analysis is valid? Again the mistake lies in applying
quantitative criteria of validity to qualitative data. Whilst two
statisticians applying the same test of statistical significance to the
same quantitative data-set might stand a good chance of arriving at the
same result, it is extremely unlikely that two ethnographers would produce
the same reading of a case study, for the same reasons that a group of
students reading the same text books would be unlikely to produce the same
essay.

As noted above, the researcher can influence the validity of an
ethnographic analysis by adopting a reflexive perspective on his or her
work, the problem resides in demonstrating this validity to the reader.
Whilst the quantitative researcher may have more convincing ways of
demonstrating validity, such as, random sampling and statistical
inference, even here there remains the need for the reader to trust in
the integrity of the researcher not to knowingly engage in deception, and
this is doubly true of qualitative research. Beyond this, the qualitative
ethnographer can strive to demonstrate the validity of the analysis by
providing a 'thick' description of the case study, and including
sufficient ethnographic data for an alternative reading to be
constructed.

Writing-up

In many accounts of the research process 'writing up' receives little
attention, or else it is treated as an independent activity from data
analysis. Hammersley and Atkinson (1983)
however, claim that writing-up is inevitably a part of the analytical
process, suggesting that the structure of the report influences the type
of analysis, or at least the way it is understood by the reader. They
identify four types of report: the 'natural history' (in which the report
reflects the different stages of the research process as they progressed
over time), the 'chronology' (also temporally organised, but reflecting
the development or 'career' of the phenomenon being studied, rather than
the research process), 'narrowing and expanding the focus' (in which the
analysis moves backwards and forwards between specific observation and
consideration of broader structural issues), and 'separating narration and
analysis' (in which the ethnographic data are presented first before
theoretical issues are addressed).

The 'natural history' approach is a very common format, particularly
for presenting quantitative findings, but it does not fit well with
qualitative research. In fact it can lead to a form of dishonesty, giving
the impression that that the research followed a tight structure of
background reading, hypothesis construction, research design, data
collection and analysis, and discussion of results. The qualitative
research process is less well ordered. Background reading is essential,
but which texts are relevant, and therefore, worth including in a report
or publication, only becomes apparent towards the end of the research
process, and the literature review should continue throughout the project
as the ethnography raises new themes for analysis. Similarly, as the above
discussion demonstrates, the sequence of hypothesis - data collection -
analysis, is not clear cut or linear, but an ongoing and dialectical
process.

The other three formats for writing-up are more relevant, but should be
seen as different aspects of the process, rather than discrete types.
Whilst the organisation of a report or publication cannot in itself confer
validity, it can make the research process more transparent to the reader
and allow validity to be more clearly assessed. It is important to use the
report format to illustrate the oscillation between micro and macro
analysis that comes from combining the methodologies of ethnography and
critical social research; looking in detail at the informants' testimony,
but broadening this out to a consideration of structural and historical
issues.

Generalisability

An important question to ask at the end of this discussion of
methodology is the extent to which the methods employed in critical
ethnography enable research findings to be generalised to other
situations. In a quantitative study generalisability is largely determined
by random sampling and statistical inference, obviously such techniques
are not usually relevant to qualitative research, making generalisation
more of a problem. In many respects, the way in which generalisation is
conceptualised in quantitative studies is alien to both ethnography and
critical social research. For the ethnographer what matters most is
gaining an in-depth understanding of the attitudes, beliefs and behaviour
of the people s/he studies; the assumption is that this worldview will be
context specific, and that generalisation to others will therefore be
extremely limited. Similarly, critical social research starts from the
assumption that society is in a constant state of flux, that the social
world and our understanding of it are constantly changing, again limiting
the value of generalisation.

However, although ethnography and critical research may question
positivist/quantitative assumptions about generalisability, both
approaches aim to produce findings that have relevance beyond the
immediate context of the study. Whilst the production of laws of behaviour
is eschewed, there remains an often almost hidden claim that the behaviour
found in the study will shed some light on the behaviour of others, even
if this explanatory range is limited in time and space. As Janet Ward-Schofield (1993) has suggested this
claim entails a re-conceptualisation of generalisability in terms
appropriate to qualitative research. She prefers the terms 'fittingness',
'comparability', or 'translatability', reflecting the process of detailed
description of the content and context of a study, so that it can be
generalised to examples that match it closely.

The use of 'thick description' to boost the generalisability of a
qualitative study, is important, but generalisability depends not just
upon detailed description of a phenomenon, but on revealing the social
relations that underpin it. For instance, a qualitative study might reveal
that 'patient empowerment' is an expression of a specific set of relations
between the state, healthcare professionals and their clients, indeed that
these relations are the condition of existence for patient
empowerment.

It might also be concluded that these relations limit the emancipatory
potential of patient empowerment, and that this limitation will apply
wherever those conditions prevail. To move beyond those conditions would
be to move beyond something that was recognisable as patient
empowerment.

Conceptualising a phenomenon in terms of its conditions of existence
and the social relations that characterise it, is a sounder basis for
generalisation than the simple description of immediate appearances. For
example, the number of people involved in a patient empowerment initiative
might change, as might the designation of the healthcare professionals,
the geographical location, even its claimed aims and objectives, but
whilst the conditions of existence and social relations that characterise
the phenomenon remain constant, then the conclusion that its emancipatory
potential is extremely limited would remain valid. By the same token, a
patient empowerment initiative might retain its outward appearance, in
terms of the people participating, its geographical location, et cetera,
but be transformed into a completely different phenomenon (with a
different degree of emancipatory potential), if change occurred in the
social relations that underpinned it. In either instance, defining the
phenomenon in terms of social relations reveals whether or not
generalisation is valid.

Conclusions

Over the last decade qualitative research has gained a new
respectability in the sociology of health, even in the more conservative
sub-discipline of medical sociology. But legitimacy has been bought at the
cost of embracing positivist criteria of reliability and validity. This
compromise has effectively burned the bridge between ethnographic
techniques of data collection and their origins in phenomenological
thought. One important consequence of transforming qualitative research
into another weapon in the positivist arsenal has been to rob the approach
of its critical potential. Rather than being a means by which researchers
and informants can jointly travel from the experiential reality of
everyday life towards a critical understanding of discourse formation and
the exercise of power, qualitative research is rapidly becoming a
mechanism of surveillance; an instrument for measuring subordination to
discourse instead of a means of countering it.

This transformation is legitimated by the bogus belief that positivist
criteria of validity confer a degree of authenticity upon research
findings that is immediately transparent to a third party. However, even
the powerful tests of validity which are available to the quantitative
researcher, such as random sampling or statistical inference, are not
immune to manipulation by disreputable researchers. Rather than a clearly
discernible hallmark of authenticity, the techniques employed in the
pursuit of validity comprise a means by which the researcher can minimise
the risk of self-deception. Whilst these techniques can be reported, their
acceptance by a third party must ultimately entail a degree of trust in
the diligence and integrity of the researcher. This does not mean that all
research findings should be blindly accepted at face value; the onus is
always on the researcher to persuade his or her audience that the research
findings are valid. The appropriate perspective for the reader of research
should be, to borrow from Antonio Gramsci, 'pessimism of the intellect,
optimism of the will', and this applies equally to quantitative and
qualitative research.

The importation of positivist criteria of validity into the qualitative
research process is not only unjustified on the grounds of scientificity,
it is also grossly inappropriate for the type of knowledge produced by
such a perspective. The aim of the qualitative researcher is not to
produce a representative and unbiased measurement of the views of a
population, but to deepen his or her understanding of a social phenomenon
by conducting an in-depth and sensitive analysis of the articulated
consciousness of actors involved in that phenomenon. Interview transcripts
and field notes are read by the ethnographer, for the same purpose that
academic texts are also considered, that is, in the hope of finding fresh
insights and new ways of understanding a particular phenomenon. Positivist
criteria of validity are quite inappropriate to this process, their
imposition reduces ethnography to the status of a 'poor relation' of
quantitative research - a means of gathering sensitive information, but
ultimately less valid.

I have argued in this paper for a re-conceptualisation of rigour and
validity in qualitative research, based on a rejection of positivist
criteria, in favour of the insights offered by social critique. From this
perspective validity can be re-couched in terms of reflexively managing
the relationship between the testimony of informants and a broader process
of structural and historical analysis. This is an uneasy and in some
senses contradictory combination that requires careful management at each
stage of the research process. However, it does provide an opportunity to
get beneath the surface of everyday appearances, to produce theoretically
informed accounts of social phenomena that are grounded in people's
experience of everyday life, but which take a critical approach to the
categories and forms through which everyday life is experienced.